回肠浆肌层补片膀胱扩大术治疗反射亢进型神经原性尿失禁的疗效随访(英文)

Follow-up study of cystectasy using a demucosalized ileoseromuscular layer patch containing neurovascular pedicle for overactive neurogenic urinary incontinence

背景:神经原性尿失禁手术治疗方法多样,疗效不一,探讨手术治疗神经原性尿失禁的效果,以求证其有效性。目的:评价去粘膜回肠浆肌层补片膀胱扩大术治疗反射亢进型神经原性尿失禁疗效,为改良手术提出建议。设计:以患者为研究对象的回顾性病例分析。单位:一所大学医院的小儿外科。对象:对郑州大学第一附属医院小儿外科自1998-04/2004-01手术治疗的68例神经原性尿失禁患者进行随访,所有患者术前均确诊为神经原性尿失禁,随访资料完整者共38例。方法:对38例反射亢进型神经原性膀胱患者随访4～69个月,平均17.2个月。患者年龄4～17岁,38例患者行去粘膜回肠浆肌层补片膀胱扩大术,34例盆底肌松弛者同时行双侧髂腰肌盆底加强术。主要观察指标:观察手术前后症状、膀胱顺应性、最大膀胱容量和相对安全膀胱容量。结果:30例(79%)尿失禁症状改善(控尿时间>1h);尿动力学检查示:所有行回肠去浆肌层膀胱扩大术患者术后均为腹压排尿,尿流动力学检查均未发现在排尿期有主动的逼尿肌收缩;术后顺应性增加(27.43±24.78)mL/kPa(P<0.01),最大膀胱容量较术前增加(122.18±79.99)mL(P<0.01),相对安全膀胱容量较术前增加(98.63±86.78)mL(P<0.01)。未发现有上尿路功能受损加重情况。结论:去粘膜回肠浆肌层补片膀胱扩大术可保护上尿路?

BACKGROUND:There are various surgical treatments to neurogenic urinary inconti nence,and the curative effects differ a lot.The present research was to study th e effect of surgical treatment of neurogenic urinary incontinence. OBJECTIVE:To evaluate the therapeutic effect of cystectasy using a demucosaliz ed ileoseromuscular layer patch containing neurovascular pedicle for the patient s with overactive neurogenic urinary incontinence to suggest for improvement in operations. DESIGN:A retrospective case analysis based on the study of the patients. SETTING:Department of pediatric surgery of a university hospital. PARTICIPANTS:A follow up study was conducted to 68 patients who were treated at the Department of Pediatric Surgery of the First Affiliated Hospital of Zheng zhou University from April 1998 to January 2004 for neurogenic urinary incontine nce. There were 38 cases with full follow up data. METHODS:All the 38 patients with overactive neurogenic urinary incotinence und erwent bladder augmentation using a demucosalized ileoseromuscular layer patch c ontaining neurovascular pedicle and were followed up for 4 to 69 months,and 17.2 months in average.Among the patients,34 with pelvic diaphragm ptosis were treat ed with pelvic diaphragm strengthening at the same time. MAIN OUTCOME MEASURES:The preoperative and postoperative symptoms, bladder com pliance and maximum bladder capacity and the relative safe bladder capacity were studied. RESULTS:Thirty of 38 patients showed improvement in the symptoms of urinary in continence(micturition interval >1 hour) after the operation.The results of urod ynamics showed that the all patients with bladder augmentation using a demucosal ized ileoseromuscular layer patch containing neurovascular pedicle urinated unde r abdominal pressure,and no active contraction of detrusor urinae was detected.T he compliance,the maximum bladder capacity and the relative safe bladder capacit y were increased by(27.43±24.78) mL/kPa(P< 0.01),(122.18±79.99) mL(P< 0.01) an d(98.63±86.78) mL(P< 0.01) respectively.No aggravation of upper urinary functio n injury was observed after the operation. CONCLUSION:The bladder augmentation using a demucosalized ileoseromuscular lay er patch ontaining neurovascular pedicle can protect the upper urinary function, and it is an effective approach to treating overactive neurogenic urinary incon tinence.